I miss my old job…

Two weeks ago, I was flying from San Francisco to Newark to do an in-house training with a drug company sales force. I was comfortably settled into my seat in first class (all those frequent flyer miles = upgrades), about to start eating the [not-too-bad] chicken dinner, when the call came out over the intercom asking if a physician was on board.

Two weeks ago, I was flying from San Francisco to Newark to do an in-house training with a drug company sales force. I was comfortably settled into my seat in first class (all those frequent flyer miles = upgrades), about to start eating the [not-too-bad] chicken dinner, when the call came out over the intercom asking if a physician was on board.

“Oh God, please God…I pray there is a hot shot medical resident or some newly minted internist, anxious to play hero.” My reluctance to respond is not due to fear or laziness or apathy. I stopped practicing over 10 years ago when I started working in the pharmaceutical industry full time. Though I continue to read all the requisite journals, and maintain an active medical license in California, I have to admit that I am rusty. I am sure I can still draw blood and start an IV, and do an uncomplicated delivery or surgery. But I have not been really hands-on for a long time.

And, luckily for me, several call buttons started ringing in response to the plea for a medical professional. Off the hook!!! Or so I thought….

A few minutes into the “emergency,” I asked the flight attendant how it was going in back, and she said there were at least two physicians on hand (great — if they need to do CPR, two rescuers are better than one). I then wisely or unwisely asked what kind of emergency. She then said something that forced me to become the first responder…”it’s a pregnant woman.” And it was a pretty sure bet that I was the only OB/GYN on the flight. I got up and headed back to coach.

I found a gravid female standing in the galley crying, and two male physicians standing there looking at her from 4 feet away. I introduced myself as an OB/GYN, and the pair of docs simultaneously smiled and appeared to exhale after a long period of breathe holding. They admitted to being cardiologists, and seemed relieved to see me.

I asked the young mother-to-be if she was in acute pain, asked the flight attendant for multiple blankets so we could lay her down on the floor and, after the preliminaries, began examining her tummy.

As I palpated the abdomen, percussed the organs, and then balloted (the act of feeling an intra-abdominal mass which is palpable and which can be “bounced” back and forth) the fetal head, sensing it float back and forth between my finger tips, I had a moment where I felt like I had no idea what I was doing. Well, I did know what I was doing. But it was like trying to play piano after not playing for years…you know where your fingers are supposed to go, but the subtleties are absent. The keys feel strange. You know how it is supposed to go, but cannot quite make it all happen. So it was with this exam.

I did everything right for this rather minor, but anxiety-provoking incident, but when all was done, the young mother and fetus apparently healthy and calmed, everyone back in their seats, it felt like an out of body experience, almost a like an alien event. I realized I have forgotten how to take a history. Though I have done hundreds of thousands of the most intimate and intimidating physical exams during my long medical career, I no longer felt like I should be touching a stranger. I felt that I no longer had the “right” to violate a physical person. And for a not so brief moment, I felt something more profound than nostalgia. I felt a longing to be a physician again. I missed my old job.

Let’s face it. Much of the time working in the pharmaceutical industry, I have no direct window to real patients, no opportunity to see how drugs make lives better. Much of my time working in medical affairs is spent serving my colleagues in marketing, or dealing with regulatory issues. Amidst a day talking about margins promotion, research costs, FDA, etc., the suffering of patients seems far and distant. I don’t hear someone say how much better they feel with a new migraine treatment. I don’t see someone’s Parkinson’s improve. I don’t feel the fever break after the antibiotic flows through the IV. I have often come home at the end of a day feeling that “health” is a by-product in the business of pharma.

But I know that much of the improvements in life expectancy and quality of life we enjoy in this country have accrued because of innovations in sanitation, vaccination, and medication, innovations directly related to the kind of R & D we do in industry.